RESOLVED: Claim Denials Based on Provider Specialty

 Current Status
 3/29/2019: Resolved. Adjustments have been completed.

Issue Identified: January 11, 2019

Issue: A system update resulted in CPT/HCPCS codes 0254T, and 34703 through 34708, to deny incorrectly when billed by nurse practitioners, physician assistants, and several physician specialty types. Denials for this issue included claim adjustment reason code 170, payment is denied when performed/billed by this type of provider, on the remittance advice.

Provider Action: There is no provider action required. Palmetto GBA will adjust affected claims processed on or after January 1, 2018. Once adjusted, the claims will continue through the processing system and all other billing and coverage guidelines will apply.

Make sure your billing personnel are aware of these instructions.

Resolved. Adjustments have been completed.

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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